Annexure-E-I. APPLICATION FORM FOR ORPHAN CERTIFICATE

Annexure E-1

UNDERTAKING

            I ………………………………….………………..….. Son/Daughter of ……………………………………………… aged …………………………..…………. Years, R/o ……………………………………       …………………………………… District ……………………………………………………….., do hereby submit the following information for claiming marks under the socio-economic criteria namely:-

(1)   That I am to apply for the post of …………………………………………………..……………………………. In HSSC against Category No…………………………….…... Advt. No. …………………………………….………, Dated ……………………………………………………………….……..

(2)   That my Aadhar No. /PAN Card No. /Voter ID No. (If any) is ……………………………………………………………………..

(3)   That my father, mother, spouse, brother and son are / were not regular employee in any Department/Board/Corporation/Company/Statutory Body/Commission/Authority of Government of Haryana or any State Government or Government of India.

(4)   That has no person as mentioned above had been in employment, I may be allotted marks under the socio-economic criteria.

(5)   That I fully understand that the marks are given on the basis of information supplied by me and if at any stage it is found that the information has been provided wrongly then not only my service can be terminated on the ground of supply of wrong information even if without these marks also my name would have figured within the select list/recommendation list. I also understand that criminal action can be taken against me for providing wrong/false information.

(6)   That the deponent shall not take advantage of the certificate(s) issued by the Competent Authority if in the meantime any other eligible person in my family obtains the benefits thereof in the recruitment.

DEPONENT

Place:-

Date:-

VERIFICATION:-

            Verified that the contents of all the above paras are true to my knowledge and belief and nothing has been concealed therein.

                                                                                                            DEPONENT

Place:-

Date:-

Download PDF:- Click Here